Physiological Changes as a Result of Hip Arthroscopy Performed With Traction
To evaluate the physiological effects of hip arthroscopy using traction on venous blood flow, nerve conduction, soft-tissue injury, fibrinolysis, and patient pain. Thirty subjects were prospectively analyzed in an institutional review board–approved study. The visual analog scale pain score, creatin...
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Published in | Arthroscopy Vol. 28; no. 10; pp. 1365 - 1372 |
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Main Authors | , , , , , |
Format | Journal Article |
Language | English |
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New York, NY
Elsevier Inc
01.10.2012
Elsevier |
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Online Access | Get full text |
ISSN | 0749-8063 1526-3231 1526-3231 |
DOI | 10.1016/j.arthro.2012.04.139 |
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Abstract | To evaluate the physiological effects of hip arthroscopy using traction on venous blood flow, nerve conduction, soft-tissue injury, fibrinolysis, and patient pain.
Thirty subjects were prospectively analyzed in an institutional review board–approved study. The visual analog scale pain score, creatine phosphokinase (CPK)–MM level, and D-dimer test were obtained preoperatively, postoperatively, and 5 days postoperatively. Doppler ultrasound (group A) (n = 15) of femoral and popliteal venous blood flow and somatosensory evoked potentials (SSEPs) (group B) (n = 15) of the posterior tibial nerve and superficial peroneal nerve were monitored intraoperatively.
Mean operation and traction times were 131.7 and 27.3 minutes, respectively. During traction (mean, 57.7 lb), decreased blood flow was determined at the popliteal vein (15 of 15 subjects) and femoral vein (4 of 15 subjects). Blood flow returned to baseline after traction in all subjects. Mean CPK-MM levels were 86.0 ± 29.6 mU/mL preoperatively, 232.1 ± 224.6 mU/mL postoperatively, and 138.1 ± 109.3 mU/mL at 5 days postoperatively. The number of subjects positive for D-dimer was 7 preoperatively, 12 postoperatively, and 21 at 5 days postoperatively. SSEPs showed a greater than 50% decrease in amplitude on the operative (8 of 15) and nonoperative (9 of 15) limbs. No significant correlations were determined between visual analog scale pain score, body mass index, CPK-MM level, traction time, or operating room time.
Doppler ultrasound showed decreased blood flow of the popliteal vein with traction, which returned to normal after traction. SSEPs showed changes with and without traction on operative and nonoperative legs. Consideration should be given for knee flexion of the contralateral leg after traction to protect nerve function. Hip arthroscopy resulted in an increase in a positive D-dimer test from immediately postoperatively to postoperative day 5. There is variability in the soft-tissue damage with hip arthroscopy, which is independent of time (<2 hours), body mass index, or pain. Traction affects the vascular and neurologic structures of the operative and nonoperative extremity independent of time.
Level IV, therapeutic case series. |
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AbstractList | Purpose To evaluate the physiological effects of hip arthroscopy using traction on venous blood flow, nerve conduction, soft-tissue injury, fibrinolysis, and patient pain. Methods Thirty subjects were prospectively analyzed in an institutional review board–approved study. The visual analog scale pain score, creatine phosphokinase (CPK)–MM level, and D-dimer test were obtained preoperatively, postoperatively, and 5 days postoperatively. Doppler ultrasound (group A) (n = 15) of femoral and popliteal venous blood flow and somatosensory evoked potentials (SSEPs) (group B) (n = 15) of the posterior tibial nerve and superficial peroneal nerve were monitored intraoperatively. Results Mean operation and traction times were 131.7 and 27.3 minutes, respectively. During traction (mean, 57.7 lb), decreased blood flow was determined at the popliteal vein (15 of 15 subjects) and femoral vein (4 of 15 subjects). Blood flow returned to baseline after traction in all subjects. Mean CPK-MM levels were 86.0 ± 29.6 mU/mL preoperatively, 232.1 ± 224.6 mU/mL postoperatively, and 138.1 ± 109.3 mU/mL at 5 days postoperatively. The number of subjects positive for D-dimer was 7 preoperatively, 12 postoperatively, and 21 at 5 days postoperatively. SSEPs showed a greater than 50% decrease in amplitude on the operative (8 of 15) and nonoperative (9 of 15) limbs. No significant correlations were determined between visual analog scale pain score, body mass index, CPK-MM level, traction time, or operating room time. Conclusions Doppler ultrasound showed decreased blood flow of the popliteal vein with traction, which returned to normal after traction. SSEPs showed changes with and without traction on operative and nonoperative legs. Consideration should be given for knee flexion of the contralateral leg after traction to protect nerve function. Hip arthroscopy resulted in an increase in a positive D-dimer test from immediately postoperatively to postoperative day 5. There is variability in the soft-tissue damage with hip arthroscopy, which is independent of time (<2 hours), body mass index, or pain. Traction affects the vascular and neurologic structures of the operative and nonoperative extremity independent of time. Level of Evidence Level IV, therapeutic case series. To evaluate the physiological effects of hip arthroscopy using traction on venous blood flow, nerve conduction, soft-tissue injury, fibrinolysis, and patient pain. Thirty subjects were prospectively analyzed in an institutional review board-approved study. The visual analog scale pain score, creatine phosphokinase (CPK)-MM level, and D-dimer test were obtained preoperatively, postoperatively, and 5 days postoperatively. Doppler ultrasound (group A) (n = 15) of femoral and popliteal venous blood flow and somatosensory evoked potentials (SSEPs) (group B) (n = 15) of the posterior tibial nerve and superficial peroneal nerve were monitored intraoperatively. Mean operation and traction times were 131.7 and 27.3 minutes, respectively. During traction (mean, 57.7 lb), decreased blood flow was determined at the popliteal vein (15 of 15 subjects) and femoral vein (4 of 15 subjects). Blood flow returned to baseline after traction in all subjects. Mean CPK-MM levels were 86.0 ± 29.6 mU/mL preoperatively, 232.1 ± 224.6 mU/mL postoperatively, and 138.1 ± 109.3 mU/mL at 5 days postoperatively. The number of subjects positive for D-dimer was 7 preoperatively, 12 postoperatively, and 21 at 5 days postoperatively. SSEPs showed a greater than 50% decrease in amplitude on the operative (8 of 15) and nonoperative (9 of 15) limbs. No significant correlations were determined between visual analog scale pain score, body mass index, CPK-MM level, traction time, or operating room time. Doppler ultrasound showed decreased blood flow of the popliteal vein with traction, which returned to normal after traction. SSEPs showed changes with and without traction on operative and nonoperative legs. Consideration should be given for knee flexion of the contralateral leg after traction to protect nerve function. Hip arthroscopy resulted in an increase in a positive D-dimer test from immediately postoperatively to postoperative day 5. There is variability in the soft-tissue damage with hip arthroscopy, which is independent of time (<2 hours), body mass index, or pain. Traction affects the vascular and neurologic structures of the operative and nonoperative extremity independent of time. Level IV, therapeutic case series. To evaluate the physiological effects of hip arthroscopy using traction on venous blood flow, nerve conduction, soft-tissue injury, fibrinolysis, and patient pain.PURPOSETo evaluate the physiological effects of hip arthroscopy using traction on venous blood flow, nerve conduction, soft-tissue injury, fibrinolysis, and patient pain.Thirty subjects were prospectively analyzed in an institutional review board-approved study. The visual analog scale pain score, creatine phosphokinase (CPK)-MM level, and D-dimer test were obtained preoperatively, postoperatively, and 5 days postoperatively. Doppler ultrasound (group A) (n = 15) of femoral and popliteal venous blood flow and somatosensory evoked potentials (SSEPs) (group B) (n = 15) of the posterior tibial nerve and superficial peroneal nerve were monitored intraoperatively.METHODSThirty subjects were prospectively analyzed in an institutional review board-approved study. The visual analog scale pain score, creatine phosphokinase (CPK)-MM level, and D-dimer test were obtained preoperatively, postoperatively, and 5 days postoperatively. Doppler ultrasound (group A) (n = 15) of femoral and popliteal venous blood flow and somatosensory evoked potentials (SSEPs) (group B) (n = 15) of the posterior tibial nerve and superficial peroneal nerve were monitored intraoperatively.Mean operation and traction times were 131.7 and 27.3 minutes, respectively. During traction (mean, 57.7 lb), decreased blood flow was determined at the popliteal vein (15 of 15 subjects) and femoral vein (4 of 15 subjects). Blood flow returned to baseline after traction in all subjects. Mean CPK-MM levels were 86.0 ± 29.6 mU/mL preoperatively, 232.1 ± 224.6 mU/mL postoperatively, and 138.1 ± 109.3 mU/mL at 5 days postoperatively. The number of subjects positive for D-dimer was 7 preoperatively, 12 postoperatively, and 21 at 5 days postoperatively. SSEPs showed a greater than 50% decrease in amplitude on the operative (8 of 15) and nonoperative (9 of 15) limbs. No significant correlations were determined between visual analog scale pain score, body mass index, CPK-MM level, traction time, or operating room time.RESULTSMean operation and traction times were 131.7 and 27.3 minutes, respectively. During traction (mean, 57.7 lb), decreased blood flow was determined at the popliteal vein (15 of 15 subjects) and femoral vein (4 of 15 subjects). Blood flow returned to baseline after traction in all subjects. Mean CPK-MM levels were 86.0 ± 29.6 mU/mL preoperatively, 232.1 ± 224.6 mU/mL postoperatively, and 138.1 ± 109.3 mU/mL at 5 days postoperatively. The number of subjects positive for D-dimer was 7 preoperatively, 12 postoperatively, and 21 at 5 days postoperatively. SSEPs showed a greater than 50% decrease in amplitude on the operative (8 of 15) and nonoperative (9 of 15) limbs. No significant correlations were determined between visual analog scale pain score, body mass index, CPK-MM level, traction time, or operating room time.Doppler ultrasound showed decreased blood flow of the popliteal vein with traction, which returned to normal after traction. SSEPs showed changes with and without traction on operative and nonoperative legs. Consideration should be given for knee flexion of the contralateral leg after traction to protect nerve function. Hip arthroscopy resulted in an increase in a positive D-dimer test from immediately postoperatively to postoperative day 5. There is variability in the soft-tissue damage with hip arthroscopy, which is independent of time (<2 hours), body mass index, or pain. Traction affects the vascular and neurologic structures of the operative and nonoperative extremity independent of time.CONCLUSIONSDoppler ultrasound showed decreased blood flow of the popliteal vein with traction, which returned to normal after traction. SSEPs showed changes with and without traction on operative and nonoperative legs. Consideration should be given for knee flexion of the contralateral leg after traction to protect nerve function. Hip arthroscopy resulted in an increase in a positive D-dimer test from immediately postoperatively to postoperative day 5. There is variability in the soft-tissue damage with hip arthroscopy, which is independent of time (<2 hours), body mass index, or pain. Traction affects the vascular and neurologic structures of the operative and nonoperative extremity independent of time.Level IV, therapeutic case series.LEVEL OF EVIDENCELevel IV, therapeutic case series. |
Author | Kelly, Bryan Martin, Hal D. Champlin, Keith Kaiser, Bill Leunig, Michael Palmer, Ian J. |
Author_xml | – sequence: 1 givenname: Hal D. surname: Martin fullname: Martin, Hal D. email: haldavidmartin@yahoo.com organization: Oklahoma Sports Science & Orthopaedics, Oklahoma City, Oklahoma, U.S.A – sequence: 2 givenname: Ian J. surname: Palmer fullname: Palmer, Ian J. organization: Oklahoma Sports Science & Orthopaedics, Oklahoma City, Oklahoma, U.S.A – sequence: 3 givenname: Keith surname: Champlin fullname: Champlin, Keith organization: College of Medicine, University of Oklahoma, Oklahoma City, Oklahoma, U.S.A – sequence: 4 givenname: Bill surname: Kaiser fullname: Kaiser, Bill organization: Pivot Medical, Sunnyvale, California, U.S.A – sequence: 5 givenname: Bryan surname: Kelly fullname: Kelly, Bryan organization: Hospital for Special Surgery, New York, New York, U.S.A – sequence: 6 givenname: Michael surname: Leunig fullname: Leunig, Michael organization: Schulthess Clinic, Zurich, Switzerland |
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Keywords | Arthroscopy Orthopedic surgery Treatment Diseases of the osteoarticular system Endoscopy Traction Hip |
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Snippet | To evaluate the physiological effects of hip arthroscopy using traction on venous blood flow, nerve conduction, soft-tissue injury, fibrinolysis, and patient... Purpose To evaluate the physiological effects of hip arthroscopy using traction on venous blood flow, nerve conduction, soft-tissue injury, fibrinolysis, and... |
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SubjectTerms | Arthroscopy Arthroscopy - methods Biological and medical sciences Endoscopy Female Hip Joint - physiopathology Hip Joint - surgery Humans Investigative techniques, diagnostic techniques (general aspects) Male Medical sciences Orthopedic surgery Orthopedics Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases Traction |
Title | Physiological Changes as a Result of Hip Arthroscopy Performed With Traction |
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